Review of Experience with Retinopathy of Prematurity from the Pavia Registry (1990-1993)

Esotropia and Pseudoexotropia in Acute Rop Sequelae: Clinical Features and Suggestions for Treatment

We report five cases with a mixture of esotropia and pseudoexotropia due to macular ectopia related cicatricial retinopathy of prematurity (ROP). On inspection, the patients, aged from 9 to 28 years, presented a divergence of the eyes and a nasally decentralised corneal light reflex. The cover test showed esodeviation. All the cases presented some clinical features common to congenital strabismus. Fundus examination showed temporal traction of vascular and retinal tissues and macular ectopia, referrable to cicatricial sequelae of spontaneously regressed severe ROP. Treatment is limited to follow-up, with attention being paid to the control of retinal damage rather than to resolving the esthetic defects. Despite cryotherapy, these conditions are increasing with the increase in severe ROP and are now relatively frequent. We suggest that they be carefully identified in order to avoid incorrect orthoptic or surgical treatment.

Retinopathy of prematurity: an optimum screening strategy

OBJECTIVE

We sought to find out whether birth weight of less than 1251 g or gestational age less than 30 weeks could provide a safe and efficient screening criteria of detecting treatable retinopathy of prematurity (ROP).

METHODS

Infants either with a birth weight less than 1500 g or gestational age less than 32 weeks were screened for ROP during an 8-year period.

RESULTS

In our study, the incidence of ROP was 36 of 187 (19.3%) infants. Although there was a slight increase in the number of infants screened over the years, the incidence of ROP of any stage remained stable. The maximum stage of ROP reached was stage 1 in 10 of 187 (5.3%), stage 2 in 8 of 187 (4.3%), and stage 3 in 18 of 187 (9.6%) infants. Among those with stage 3 disease, threshold ROP was present in 16 of 18 (88.9%). All infants with threshold ROP had a BW less than 1100 g and gestational age less than or equal to 28 weeks. Significantly fewer babies (105/187, or 56%) would have been examined had inclusion criteria of a birth weight of less than 1251 g and gestational age less than 30 weeks been applied. In addition, 31% (134/437) of screening examinations could have been avoided.

CONCLUSIONS

Our study suggests that a birth weight of less than 1251 g and gestational age less than 30 weeks can be safely and efficiently used to screen infants without missing a diagnosis of sight-threatening ROP in our catchment population.

Retinopathy of prematurity and other ocular problems in premature infants weighing less than 1500 g at birth

PURPOSE

To estimate the incidence of retinopathy of prematurity and other ocular problems in a population of preterm infants.

METHODS

This retrospective study included all infants with gestational age (GA) <32 weeks and birth weight (BW) <1500 g cared for in the neonatal intensive care unit (NICU) over a period of nine years (1992-2000). Ophthalmological examination was started the 4th week of life and included refractive examination, examination of the cornea and funduscopy under mydriasis. An ocular motility test was done after the 2nd month.

RESULTS

The study included 194 infants. Stage I and II retinopathy occurred in 51 infants but regressed spontaneously. Five of the 194 (2.5%) had to undergo cryopexy. Optic disc atrophy was observed in association with peri-intraventricular hemorrhage (PIIVH) (grade IV) in seven infants. Fifteen infants (7.7%) had retinal hemorrhages which were absorbed by three months of age. Almost 20% of the study infants developed high refractive errors and 13.4% strabismus.

CONCLUSIONS

Not only retinopathy of prematurity, but other serious ocular problems were observed in this population of preterm infants. The role of PIIVH III-IV in the pathogenesis of certain ocular problems needs further elucidation.

Retinopathy of prematurity: are we screening too many babies?

PURPOSE

With advancement in neonatal care units, early detection of retinopathy of prematurity (ROP) in premature and very-low-birth-weight infants is important. Numerous studies have reported an increased risk of ROP in prematurely born infants, but only few have been long-term and strictly population-based. The aim of the present study was to find out whether birthweight <1251 grams and gestational age <30 weeks could provide a safe and efficient means of detecting treatable ROP. We have retrospectively tried to ascertain the incidence and associated risk factors that may contribute to the management of babies with ROP.

METHODS

Infants either with a birth weight below 1500 g or a gestational age of less than 32 weeks were screened for ROP during an 8-year period by a single examiner. Results An incidence of 64/205 (31.2%) ROP was noted. The mean age at detection was 5.5 +/- 2 weeks of life. The maximum stage reached was stage 1 in 27 (13.2%), stage 2 in 24 (11.7%) and stage 3 in 10 (4.8%) babies. Threshold ROP was present in three (1.5%) babies. Significantly fewer (150/205 = 73%) babies would have been examined had a birth weight of <1251 grams and a gestational age <30 weeks been applied. there were five (8%) babies with birth weight >1250 grams and eight (12%) babies with gestational age >30 weeks amongst babies with ROP but all were stage 1 or stage 2. All the stage 3 ROP and the threshold ROP cases were babies with birth weight <1000 grams and gestational age below 28 weeks.

CONCLUSION

Ophthalmic examination may be safely and efficiently concentrated in babies with birth weight <1251 grams and gestational age below 30 weeks. Birth weight (P < 0.005) and gestational age (P < 0.01) were the only significant risk factors. During this 8-year period there was no significant decrease in the number of babies screened for ROP and the overall incidence of all stages of the disease has remained constant. In the present series a lower incidence of severe ROP was noted compared to most previous studies. Our experience from this study suggests the need for further refinement of screening guidelines in order to focus screening on the vision-threatening stages of ROP.